Wages and Benefits

This report offers the findings of an outreach project conducted with direct-care employers and employees in Maine to help connect them with a new health insurance product called DirigoChoice. The research suggest that “states experimenting with innovative health coverage plans will need to address major challenges -- such as the part-time nature of direct-care work, low wages, and low reimbursement rates -- to ensure coverage for these critical health care workers.”

The Arkansas IndependentChoices program developed two new tools. The Consumer-Directed training manual will provide users with ideas and suggestions on hiring, training, and managing a personal care attendant. The Personal Care Attendant handbook will provide users with training material that will help trainees do their job as a personal care attendant. Both manuals contain information about hiring, communication and management issues.

To improve long-term care quality, state and federal policymakers are experimenting with positive incentives to reward providers who can demonstrate better quality. Incentive payment systems are part of a broader trend in the health care field, referred to as “pay-for-performance” and may consist of either financial payments or non-financial recognition. This paper describes the challenges involved in designing effective quality incentive payment systems in the long-term care sector.

In 2004, Congress requested that HHS conduct a study on the shortage of direct support professionals (DSPs) supporting persons with intellectual disabilities and other developmental disabilities (ID/DD). The study includes an examination of the causes associated with high vacancy and turnover rates, and an examination of the impact this shortage may be having on services for people with ID/DD. The report offers figures on projected needs and future demands of worker recruitment and retention.

Managed by the Home Care Quality Authority (HCQA), a public agency in Washington, this Registry is a customized internet-based system designed to match the needs of publicly funded in-home consumers/employers with pre-qualified individual providers. The day-to-day operations are administered by Referral and Workforce Resource Centers (RWRCs). Local sites offer programs and services including referral searches, a Resource Clearinghouse and outreach materials such as the attached newsletter.

Launched by CMS, the center provides information and assistance to state and local governments, policy makers, researchers, employers, workers and consumers. The Resource Center offers a comprehensive on-line database, information through a toll-free telephone number, and individualized, in-depth technical assistance for selected State Medicaid Agencies. Visit the site for best practices and other materials to increase the quality of the workforce and enhance recruitment and retention.

Research findings show that older workers are interested in direct care jobs and that long-term care employers view older workers as being able to provide better quality care - presenting one potential solution to a workforce shortage. This study was the first to explore the feasibility of engaging older workers. Telephone interviews were conducted with almost 700 lower-income job seekers in the seven states. These findings show a real potential for hiring older persons as frontline workers.

A new site from the Paraprofessional Healthcare Institute, the Health Care for Health Care Workers (HCHCW) initiative houses information about the widespread lack of health care coverage among direct-care workers. The number of uninsured is rising while demand for direct care grows and HCHCW is working to reverse that trend. Website sections include: The Health Insurance Crisis Overview, Resources, Campaigns, Related Initiatives, Telling Our Stories, and a Newsroom.

The Granite State Independent Living (GSIL) program has developed two great resources offered to providers of personal care and homemaking services. This employee handbook is intended to serve as a guideline, describing the policies and procedures of GSIL’s two Attendant Care Programs, the Personal Care Attendant (PCA) Program and the Personal Care Services (PCS) Program for consumers and employees. The Skills Training notebook offers agency information and various policies.

Long-term care providers are often skeptical of the value of engaging in government workforce development initiatives. This Issue Brief examines the reluctance to invest and highlights five examples of successful partnerships between employers and workforce development networks. Partnerships are seeking to change business as usual to improve the quality of care, increase the supply of direct care workers and promote greater workforce stability through higher retention and lower turnover.